Proper diagnostic sequence?

[RADIOFLYER]

45 yr old female, family history of hypo and hyper thyroid disorders.

Symptoms:
Rapid weight loss - 75 lbs in 5 months - normal dietary intake
Hair loss
Extreme sweating episodes
Fatiuge

Radiology Report has determined that I have 6 nodules:
normal gland size
rt. lobe findings - all solid nodules
13X10mm mid to upper pole - isoechoic and well defined margins (hot nodule)
16X14 mm mid lobe - isoechoic and well defined margins
12X9 mm lower pole -  hypoechoic and heterogenous
lt. lobe findings - all solid nodules
18X15mm mid to upper pole laterally - hypoechoic and well defined margins
10X7 mm lower pole medially - hypoechoic and well defined margins
16X13 mm lower pole -  hypoechoic and well defined margins (hot nodule)

TSH has dropped 50% in three weeks (now at the lower limit of normal range) - two blood test completed
TSI is above normal with second series of blood work - (hyperactive 1.6 )(1.3 upper range)

From a medical perspective....

Q: What would you recommend as the next course of action?  
Q: Wait 6-8 months and re-evaluate?
Q: FNA?  
Q: What terms in the radiology report would cause concern?

[worriedinmd]

utahmomma is right. trust your instincts and do the best you can to see someone else. you have to be your own best advocate when it comes to your health.

- viv

[utahmomma]

Grrrrr to doctors who don't listen, think they are god, and discount patients!

As for your question - it's possible (but not highly likely).  Malignancy can hide in just about anything and only two of your nodules are hot.

If it was me, I'd get on a waiting list for another endo.

Sorry.  (stupid doctors!)  :-(

[RADIOFLYER]

Thanks Utahmomma.

The discussion with the Endo went like this - when I mentioned the possibility of a thyroid storm occurring?...A:NO, its not possible.

The 8 month wait is the time the Endo is out of state working at a "sister" facility.

The lab work change is his response to having bad lab work (from another lab) to begin with. I beg to differ...some variables might occur in the results...but not by that much.  I can feel the difference, physically.  I have been healthy until this....not even being the type to take aspirin.

Size or other radiology related features mentioned in the report material (with CD of Ultrasound, Color Doppler, chest x-ray and scan provided) were discounted and not reviewed because they were not completed at his medical facility.  He was leaving town...would order new work up when he returns in 8 months.

In short, for now....it's waiting until June for the remote possibility to book an appointment with another Endo who I think may be able to help (based on reputation).

My primary has disappeared in this process (along with referring me to anyone else in the area....mailing me a list of doctors to choose from) and the Radiologist has been great (driving the testing train). It seems as though, he has been the only one who has been on the money with his diagnostics and reports as far as I can tell.

Q: Is there a chance to have malignancy also occurring with two hot nodules present?

Anyway, thanks again for the information...its been a huge help and relief.

[utahmomma]

No medical professionals here, just professional thyroid patients.  :-)

Here's a great article that has a flow-chart type of sequence for thyroid nodule treatment:  http://www.aafp.org/afp/20030201/559.html

The worrisome conditions you have:
-  Your TSH has dropped so rapidly (have any of your doctors talked to you about the possibility of thyroid storm?)
-  Having "hot" nodules is worrisome because of how much it affects your TSH
-  The size of a few of your nodules are large enough that they may be displacing some neck structures
-  Solid nodules are always more concerning than cystic nodules.

According to the medical article I reference above, "wait and see" would *not* be recommended in your case because of the hot nodules and the rapid drop in your TSH.

Hope this helps a little bit.

Utahmomma
papillary carcinoma '03